Impact of SAFAR Air Quality Forecasting Framework and Advisory Services in Reducing the Economic Health Burden of India

The economic loss attributable to air pollution and associated disease burden is increasing in polluted megacities all over the globe; Indian megacities are no exception. India has launched the System of Air Quality and Weather Forecasting and Research (SAFAR) framework to provide air pollution health advisories well in advance through various outreach activities. We hereby estimate the economic benefit of SAFAR outreach attributed to prevention by intervention through an early warning based on a probabilistic scenario adopted in this work for the top two megacities of India, namely, Delhi and Pune, for the period 2011-2012 to 2019-2020 and 2014-2015 to 2019-2020 respectively. This study considers the cost-saving in pulmonary (Asthma, COPD, etc.) and other related diseases linked to air pollution. Results show that the annual average total cost of all diseases in Pune and Delhi is INR 9,480 million and INR 76,940 million respectively. We found that the total annual treatment cost of Allergic rhinitis OPD treatment cost was the highest (INR 14,490 Million) followed by asthma (INR 10,010 Million), and COPD (INR 5,140 Million) in Delhi during the year 2012. In Pune, annual treatment costs of Allergic Rhinitis, COPD and Asthma were INR 3,590, 890 and 710 Million respectively during the year 2015. SAFAR framework can make average annual savings of ≃INR 10,960 million in Delhi and ≃INR 1,000 million in Pune in the health sector, even if only 5% of the total affected sick population takes advantage of its services. Looking at the huge economic benefits, it is envisaged that the SAFAR framework model may be replicated in many more cities along with other mitigation measures rigorously.

Variables affecting pricing of orphan drugs: the Italian case

Background and aim Evidence on determinants of prices for orphan medicines is scarce and not available for Italy. The aim of this paper is to provide an evidence on variables affecting the annual treatment cost of orphan drugs in Italy, testing the hypothesis of a negative correlation with the dimension of the target population and a positive correlation with the added therapeutic value of the drug and the quality of the evidence of pivotal studies. Methods Drugs with a European orphan designation reimbursed in Italy in the last 6 years (2014–2019) were considered. Univariate, cluster analysis and multiple regression models were used to investigate the correlation between the annual treatment cost and, as explanatory variables, the dimension of the target population, the existence of Randomized Clinical Trials as a proxy of the quality of the pivotal studies, the added therapeutic value. Results In the univariate analysis prevalence and added therapeutic value, as expected, have a negative and positive correlation with cost respectively. The correlation with RCT is not significant. In the multivariate model, coefficients for prevalence and added value are confirmed but for the latter are not significant anymore. We also found, through an interaction analysis, that the existence of an RCT has a positive impact on annual treatment cost when the target population is very small. Conclusions Our results suggest that value arguments and sustainability (dimension of the target population and its impact on budget impact) issues are considered for orphan drugs pricing: the role played by sustainability is systematically supported by our results. A more transparent and reproducible price negotiation process for orphan drugs is needed in Italy. This paper has contributed to highlight the implicit drivers of this process.

Treatment cost of HIV/AIDS in Turkey

PurposeThe purpose of this study is to estimate the average cost of treatment and investigate the related parameters of HIV/AIDS among patients based on their annual treatment regime during the 2017 in Izmir.Design/methodology/approachThe average annual direct cost of an HIV patient's treatment was estimated for 2017 at four university hospitals in a retrospective study in Izmir, Turkey. Inclusion criteria included confirmed HIV infection, age = 18 years, visited one of the hospitals at least three times a year and with at least one CD4+ T cell count. The average annual treatment cost per patient was calculated using accounting data for 527 patients from the hospitals' electronic databases.FindingsThe mean treatment cost per patient was US$4,381.93. Costs for treatment and care were statistically significantly higher (US$5,970.55) for patients with CD4+ T cell counts of fewer than 200 cells/mm3 than for other patients with CD4+ T cell counts above 200 cells/mm3. The mean treatment cost for patients who were 50 years old or older (US$4,904.24) was statistically significantly higher than for those younger than 50 years (US$4,216.10). The mean treatment cost for female patients (US$4,624.92) was higher than that of male patients ($US4,339.72), although the difference was not statistically significant. The main cost driver was antiretroviral treatment (US$3,852.38 per patient), accounting for almost 88% of all costs. However, the high burden of antiretroviral treatment cost is counterbalanced by relatively low care and hospitalization costs in Turkey.Originality/valueThe paper contributes to the literature by providing average annual treatment cost of an HIV-infected patient in Turkey by using a comprehensive bottom up approach. Moreover, cost drivers of HIV treatment are investigated.

The application of multi-criteria decision analysis to inform in resource allocation

Background: There is a perception held by payers that orphan products are expensive. As a result, the current health technology assessment systems might be too restrictive for orphan drugs, therefore potentially denying patients access to life-saving medicines. While price is important, it should be considered in relation to a broader range of disease-related product attributes that are not necessarily considered by many health technology assessment agencies. To overcome these challenges, multi-criteria decision analysis has been proposed as an alternative to evaluate technologies. Methods: A targeted literature review was conducted to identify the most frequently cited attributes in multi-criteria decision analysis (MCDA) in rare diseases. From the leading attributes identified, we developed a multi-criteria decision analysis framework with which to aggregate the orphan drug values. We subsequently reviewed and plotted the relationship between single attributes and the average annual treatment costs for 8 drugs used in the treatment of rare endocrine diseases. The annual treatment costs were based on UK list prices for the average daily dose per patient. Results: The five most frequently mentioned attributes in the literature were as follows: Disease severity, Unmet need (or availability of therapeutic alternatives), Comparative effectiveness or efficacy, Quality of evidence and Safety & tolerability. Results from the multi-criteria decision analysis framework indicate a wide range of average annual per-patients costs for drugs intended for the same diseases, and likewise for diseases with a similar level of Disease severity. Conclusions: Multi-criteria decision analysis may offer a viable alternative to support discussion in reimbursement decisions for orphan drugs. The analyses can be used to inform investigations on the application of MCDAs in rare diseases.

Comparison of Repeated Doses of Ivermectin Versus Ivermectin Plus Albendazole for the Treatment of Onchocerciasis: A Randomized, Open-label, Clinical Trial

Background Improved treatment for onchocerciasis is needed to accelerate onchocerciasis elimination in Africa. Aiming to better exploit registered drugs, this study was undertaken to determine whether annual or semiannual treatment with ivermectin (IVM; 200 µg/kg) plus albendazole (ALB; 800 mg single dose) is superior to IVM alone. Methods This trial was performed in Ghana and included 272 participants with microfilariae (MF), who were randomly assigned to 4 treatment arms: (1) IVM annually at 0, 12, and 24 months; (2) IVM semiannually at 0, 6, 12, 18, and 24 months; (3) IVM+ALB annually; or (4) IVM+ALB semiannually. Microfiladermia was determined pretreatment and at 6, 18, and 36 months. The primary outcome was the proportion of fertile and viable female worms in onchocercomata excised at 36 months. Results Posttreatment nodule histology showed that 15/135 (11.1%), 22/155 (14.2%), 35/154 (22.7%), and 20/125 (16.0%) living female worms had normal embryogenesis in the IVM annual, IVM semiannual, IVM+ALB annual, and IVM+ALB semiannual groups, respectively (P = .1229). Proportions of dead worms also did not differ between the 4 groups (P = .9198). Proportions of patients without MF at 36 months (1 year after the last treatment) were 35/56 (63%) after annual IVM, 42/59 (71%) after semiannual IVM, 39/64 (61%) after annual IVM+ALB, and 43/53 (81%) after semiannual IVM+ALB. Conclusions The combination treatment of IVM plus ALB was no better than IVM alone for sterilizing, killing adult worms, or achieving sustained MF clearance. However, semiannual treatment was superior to annual treatment for achieving sustained clearance of Onchocerca volvulus MF from the skin (P = .024). Clinical Trials Registration ISRCTN50035143

Evaluating Costs of Biologic Drugs for the Treatment of Moderate-to-Severe Psoriasis in the United States

Objective:To provide a contemporary comparative assessment of biologic drug costs and cost effectiveness for treating moderate-to-severe psoriasis in the United States.Methods:A literature search was conducted in PubMed on October 4, 2018 with the search terms of “psoriasis,” “biologic,” and “cost” with a filter of publication dates within the last 5 years (2014-2018). Studies included in this review were required to be conducted from a United States perspective.Results:Of the 16 studies retrieved, the costs associated with use of biologic drugs for the treatment of moderate-to-severe psoriasis were relatively high, with some drugs exhibiting sustained lower costs than others. Some comparative findings on the cost-effectiveness of biologic drugs based on the annual treatment cost per Psoriasis Area and Severity Index (PASI) 75 responder concluded that the annual treatment cost was lowest for brodalumab 210 mg at US$48 782; the cost was highest for ustekinumab 45/90 mg (US$87 243), followed by adalimumab 40 mg (US$82 655), ixekizumab 160 mg (US$77 957), and secukinumab 300 mg (US$75 671). The annual treatment cost per PASI 100 responder was also lowest for brodalumab at US$87 585. This pattern remained consistent in other cost studies, with brodalumab being the treatment with the lowest treatment costs when compared to other biologic drugs.Conclusion:Brodalumab was consistently observed to be the least costly treatment option among biologic drugs used to treat moderate-to-severe psoriasis in the United States, which is largely the result of its low-drug cost and high-PASI response rate.

Longitudinal Comparison of Patient-Level Outcomes and Costs Across Prostate Cancer Treatments With Urinary Problems

Prostate cancer (PCa) is the leading cancer in men in the United States. This study evaluated direct costs of treating urinary problems after PCa treatments and determined predictors of long-term costs for urinary problems. Data from the Cancer of Prostate Strategic Urologic Research Endeavor registry was analyzed for this study. Annual treatment costs for urinary problems for up to 14 years were compared among different primary PCa treatments, which included radical prostatectomy, external beam radiation therapy, brachytherapy, and watchful waiting. A multivariate generalized estimating equation (GEE) model with bootstrapping was estimated to identify the predictors associated with treatment costs for urinary problems. A total of 3,062 eligible patients were identified with a mean age of 65 years at diagnosis. Mean annual treatment cost for urinary problems across all patients with PCa was $118/patient. Those greater than 74 years old had the highest cost ($238/patient). Mean annual cost for urinary problems among only those with urinary problems was $432. Multivariate regression showed patients undergoing radical prostatectomy had significantly lower (−63%, p = .01) costs for urinary problems than those treated with watchful waiting. This study helps to understand the importance of treating urinary problems associated with different PCa treatments and highlights their medical care costs. The pattern of treatment costs for urinary problems across all PCa treatments suggests that clinicians need to offer treatment for urinary problems to all PCa patients over longer time periods, even to those choosing watchful waiting.